Key Points
Î "Persistent infant wheezing" is herein defined as recurrent or
persistent episodes of wheezing in infants <24 months old.
Î Wheezing occurs commonly during infancy. In most cases,
wheezing episodes are mild and easily treated. However, some
infants will develop persistent or recurrent wheezing, which is
often severe.
Î Guidelines for diagnostic testing are lacking for wheezing
infants.
Î These guidelines address diagnostic tests that are frequently
considered by pediatric pulmonologists and other clinicians
when evaluating infantile wheezing, but are either controversial
or a frequent source of uncertainty.
Î For infants with persistent wheezing despite treatment
with bronchodilators, inhaled corticosteroids, or systemic
corticosteroids, the ATS suggests an airway survey via flexible
fiberoptic bronchoscopy (conditional recommendation, very low
quality of evidence).
Î For infants with persistent wheezing despite treatment
with bronchodilators, inhaled corticosteroids, or systemic
corticosteroids, the ATS suggests bronchoalveolar lavage (BAL)
(conditional recommendation, very low quality of evidence).
Î The ATS recommends research studies in infants with persistent
wheezing despite treatment with bronchodilators, inhaled
corticosteroids, or systemic corticosteroids, which compare
clinical outcomes among those who are managed according to
results from infant pulmonary function testing using the raised-
volume rapid thoracoabdominal compression (RVRTC) method
versus those who are managed according to clinical assessment
alone.
Diagnosis
